Mission: Lifeline Hospital Accreditation Webinar. June 21, :00PM 3:00PM CST

Transcription

1 Mission: Lifeline Hospital Accreditation Webinar June 21, :00PM 3:00PM CST

2 Speaker Introductions Deb Koeppen, RN Society of Chest Pain Centers Director of Business Development Larry Brown, RN, BSN St. Luke s Episcopal Hospital, Houston, TX STEMI Coordinator Susan Rogers, RN, MSN American College of Cardiology Associate Director, ACTION Registry 6/21/ , American Heart Association 2

3 Speaker: Deb Koeppen, RN Director of Business Development Society of Chest Pain Centers 2012, American Heart Association 3

4 New Relationship New Relationship Between the American Heart Association Mission: Lifeline and the Society of Chest Pain Centers The American Heart Association's Mission:Lifeline seeks to save lives by closing the gaps that separate STEMI patients from timely access to appropriate treatments The Society of Chest Pain Centers provides an operational model for performance improvement Both organizations have a shared goal of improving the consistency of cardiac care by providing hospitals a standard approach for the treatment of STEMI patients September of 2011 organizations launched co-branded program 6/21/ , American Heart Association 4

5 Why Combining the American Heart Association's Mission:Lifeline Accreditation with SCPC's Chest Pain Center Accreditation, further assists in improving patient outcomes and by providing a comprehensive approach to treat patients with acute coronary syndromes, including STEMI. 6/21/ , American Heart Association 5

6 Collaboration The Society of Chest Pain Centers and the American Heart Association mutually agree that providing cardiac accreditation programs is in the best interest of patients, meets the needs of the healthcare community, and will help to significantly improve cardiac outcomes. 6/21/ , American Heart Association 6

7 Mission Lifeline Accreditation SCPC will offer all 2011 AHA Mission: Lifeline awarded hospitals the opportunity to become accredited alone or in conjunction with SCPC accreditation. Hospitals that are currently recognized as an accredited Chest Pain Center or intend to apply for Chest Pain Center accreditation will have the opportunity to add Mission: Lifeline accreditation by meeting relevant additional criteria. 6/21/ , American Heart Association 7

8 The Society of Chest Pain Centers Founded in 1998 by cardiologists and emergency medicine physicians Nonprofit cross-specialty organization Mission driven Provides multiple comprehensive cardiovascular accreditations and education Encompasses the entire facility along with the community, much like a trauma center 6/21/ , American Heart Association 8

9 SCPC s Accreditations & Certifications 9

10 2011, American Heart Association

11 What is Mission: Lifeline? Promote the ideal STEMI systems of care Help STEMI patients get the life-saving care they need in time Bring together healthcare resources into an efficient, synergistic system Improve overall quality of care 6/21/ , American Heart Association 11

12 Addresses the continuum of care for STEMI patients Preserves a role for the local STEMI-referral hospital Understands the issues specific to rural communities Promotes different solutions/protocols for rural vs. urban/suburban areas Recognizes there is no one-size-fits-all solution Knows the issues of implementing national recommendations on a community level 2012, American Heart Association 12

13 Mission: Lifeline 2012, American Heart Association 13

14 Mission: Lifeline Accreditation ML Hospital Registration ML System Registration Recognition Participation Quality Improvement/ Data Analysis Memorandum of Understanding 2012, American Heart Association 14

15 STEMI Systems Coverage 2012, American Heart Association 15

16 Mission: Lifeline Recognition BRONZE SILVER GOLD 1 calendar quarter/90 consecutive days 4 calendar quarters for 12 consecutive months 8 Consecutive quarters for 24+ consecutive months 6/21/ , American Heart Association 16

17 Not already a Mission: Lifeline hospital? Register with Sites must have a completed Data Release Consent Form 2012, American Heart Association 17

18 Mission: Lifeline Accreditation - What Hospitals Are Eligible? The facility must be a current AHA Mission: Lifeline Gold, Silver, or Bronze award recognition recipient. 131 hospitals earned this honor in hospitals earned this honor in 2012 Announced in U.S. News & World Report (July) 2012, American Heart Association 18

19 Application Process Purchase the American Heart Association's Mission:Lifeline Accreditation Manual provided by the Society of Chest Pain Centers at Determine which American Heart Association's Mission: Lifeline Accreditation Tracks you will be applying for: Track 1: STEMI Referral Center for those facilities that transfer their STEMI patients to a PCI STEMI receiving Center Track 2: STEMI Receiving Center for facilities who perform on-site primary PCI for STEMI patients 24/7 Complete all application documents and mail to the Society of Chest Pain Centers. 2012, American Heart Association 19

20 Fees In conjunction with CPC Accreditation - $7,000 Any facility that has either submitted their application for Cycle III CPC Accreditation, earned Cycle III CPC Accreditation, earned Cycle IV CPC Accreditation, or will apply for Cycle IV CPC Accreditation, can add Mission: Lifeline Accreditation for $7,000. The facility must be a current Mission: Lifeline recognition recipient at the time the Mission: Lifeline Accreditation application is submitted. The Mission: Lifeline Accreditation will expire when the facility s current cycle of CPC Accreditation expires. Standalone accreditation - $20,000 For facilities that choose not to pursue CPC Accreditation The Mission: Lifeline Accreditation will expire in three years 2012, American Heart Association 20

21 American Heart Association s M: L Accreditation Eligibility and Application Process Accreditation Application Business and Accreditation Agreements Facility Information Mission: Lifeline Requirement Tracks Site Review Mission: Lifeline Glossary Resources and References , American Heart Association

22 , American Heart Association

23 After the Application Once all the documentation is received by the Society of Chest Pain Centers your application will be reviewed for eligibility, requirements, and completeness of the application. The facility will be assigned to an Accreditation Review Specialist who will contact the facility representative to schedule a site review date if required. The Accreditation Review Specialist will review all supporting documentation to verify that your facility has met the American Heart Association's Mission:Lifeline Accreditation requirements provided by the Society of Chest Pain Centers. 2012, American Heart Association 23

24 Why Achieve Mission: Lifeline Accreditation? NATURAL PROGRESSION for Mission: Lifeline recognized hospitals to achieve accreditation status. IMPROVE CARDIAC CARE by providing a standardized, team approach to the treatment of STEMI patients. FORWARD THE MISSION of both organizations with a combined goal to improve the consistency of cardiac care. STRENGTHENS COMMUNITY CONFIDENCE in the quality and safety of care, treatment and services by the distinguished recognition of the AHA brand. Hospitals will be able to use the AHA S ACCREDITATION HEART CHECK MARK to promote their accomplishment. 2012, American Heart Association 24

25 Speaker: Larry Brown, RN, BSN STEMI Coordinator St. Luke s Episcopal Hospital Houston, TX 2012, American Heart Association 25

26 St. Luke s Episcopal Hospital Houston, TX Hospital awarded accreditation as a Mission: Lifeline Heart Attack Receiving Center by the AHA and SCPC in Provides 6 steps hospitals can follow to become an accredited Heart Attack Referring/Receiving Center , American Heart Association 26

27 6 Steps to Achieve Heart Attack Referring/Receiving Center Accreditation 1. Minimum Bronze level recognition from Action Registry GWTG (AR-G) 85% composite scores no score < 75% 2012, American Heart Association 27

28 6 Steps to Achieve Heart Attack Referring/Receiving Center Accreditation 2. Monitor Data Closely Real time data evaluation: critical to improving and maintaining a quality STEMI program. Recognized STEMI Coordinator» < hr case review with timeline to all clinicians» Develop data collection system to monitor individual specific parameters» Identify trends in outliers for individual segment parameters (i.e. door to ecg, ecg to page, team member response times, etc.)» Monitoring just the D2b or E2b times won t identify the source of outliers and identify OFI s» Retrospective monitor from registry data WON T get the job done! 2012, American Heart Association 28

29 6 Steps to Achieve Heart Attack Referring/Receiving Center Accreditation 3. Focus on E2B Times The most challenging requirements we faced was reaching a GWTG award was consistently achieving a E2B time < 90 min. Key: Communication Establish clear protocols. (jointly with EMS) Who determines an ECG meets STEMI guidelines? (paramedic, RN, ED physician) Advance activation - When and who initiates the STEMI alert? Clear line of responsibility for all clinicians Feedback: Concurrent case evaluation to all clinicians. 2012, American Heart Association 29

30 6 Steps to Achieve Heart Attack Referring/Receiving Center Accreditation 4. Apply for Accreditation The accreditation program significantly raises the bar above achieving M:L recognition award status: Physician credentialing (# cases, CME s, privileging criteria, etc.) Patient volume requirements Hospital No diversion policy for STEMI Monthly interdisciplinary committee participation Quality improvement process On-site evaluation by a SCPC surveyor to determine whether the hospital is up to par. 2012, American Heart Association 30

31 6 Steps to Achieve Heart Attack Referring/Receiving Center Accreditation 5. Build a Relationship with EMS (partnership not a dictatorship!) Recognizes and acknowledge EMS contribution to the rapid treatment of STEMI patients. Advance activation of STEMI team is essential to meet the E2b time. Encourage EMS to stay in the cath lab and observe PCI procedure. Offer education: be creative - day internship in cath lab, etc. Rely on EMS ECG s don t duplicate on arrival in ED sends the wrong message to EMS! EMS records in the In-patient chart; they are essential to document a compete time-line. Provide a space in ED for paramedics stock with snacks! 2012, American Heart Association 31

32 6 Steps to Achieve Heart Attack Referring/Receiving Center Accreditation 6. Establish Ongoing Education Programs Mock STEMI drills with EMS, ED, and cath lab Film them, home movie cam works great, participants review, etc. In-house staff education program for IP STEMI response Sponsor ECG training to EMS They will welcome you with open arms Education to transfer hospitals on process development, protocols, clinical education, and case feedback Takes time and effort by the STEMI Coordinator but it is worth it. Case reviews: Can and should be more then a statistics! 2012, American Heart Association 32

33 #11 ( ) SLEH # HFD # Unit#: S033/D STEMI CASE REVIEW EMS direct admit (EMS transmitted ECG 10:46: ST elevation V2-V6 Total occlusion of the proximal LAD 83 year old male patient with a significant cardiac Hx including stents placement. The patient had been scheduled to have shoulder surgery in 2 days and had been ordered by his physician to stop Plavix and asa. On ems arrival the patient was c/o nausea and mild chest pain similar to previously experienced upper GI symptoms. An ECG showed ST elevation in anterior lateral leads and was transmitted to triage. Shortly after initial assessment the patient experienced a drop in b/p to 70 systolic and oxygen saturation dropped and patient became diaphoretic. A repeat ECG reconfirmed STEMI. An IV was started and asa given. On arrival in ED the patient was assessed by cardiology and directly transported to the cath lab. Angiograms showed a total occlusion of the LAD and a 90% mid RCA lesion. A previously implanted stent was identified in the proximal LAD and was identified as the culprit lesion. The lesion was quickly ballooned and stented. The procedure was accomplished without complications. Cardiac enzymes drawn on admission were all negative. Eight hours post admit all enzymes were significantly elevated. 24 hours post procedure the patient is doing well; no c/o chest pain. The patient is scheduled to return to the cath lab this afternoon or tomorrow morning for intervention on the RCA. 911 call: 10:19 EMS at Patient: 10:38 ECG preformed: 10:46 ECG transmission received: 10:50 Patient arrival at triage: 11:07 Admit to CCL 11:21 1 st intervention: 11: to pt: 19 min pt to ECG: 7 min ECG to transmission rec ed: 4 min pt to arrival at SLEH: 28 min SLEH arrival to CCL admit: 14 min pt to balloon (E2b): 70 min SLEH D2b: 42 min Post stent proximal LAD

34 Ideas to promote Accreditation Advertise locally Bulk mailing to 911 EMS providers, potential non-pci transfer facilities, public Newspaper article in rural hospital area of successful transfer stories TV community interest interview with cardiologist and patient Mail an accreditation announcement to 911 providers and potential non-pci transfer hospitals Billboards - determined to be too difficult to convey message Transfer facility Flyers to post in ED waiting rooms advertising partnership with PCI hospital Patient stories in local newspapers In-house announcements Banners Certificates framed and displayed in waiting rooms 2012, American Heart Association 34

35 Banner for display at various locations within hospital CCU ED Cath Lab, Waiting rooms Hospital entrances 7 high x 3 wide

36 Announcement to potential non-pci hospital transfer facilities 2012, American Heart Association 36

37 Bulk large post card mailing to all Houston Fire Station/EMS and all local 911 EMS providers 2012, American Heart Association 37

38 Bulk large post card mailing to public in specific zip codes close to hospital 2012, American Heart Association 38

39 Attach THANK YOU note to snack packs of cookies for EMS week promotion! 2012, American Heart Association 39

40 Poster for relationship with transfer hospital Can be used for advertising in various locations in hospital: ER Hallways Waiting Rooms 2012, American Heart Association 40

41 Speaker: Susan Rogers, RN, MSN, NE-BS Associate Director ACTION Registry-GWTG ACTION Registry-GWTG -No Disclosures 2012, American Heart Association 41

42 What is National Cardiovascular Data Registry? 1998 CathPCI 2006 ICD 2007 CARE 2008 ACTION- GWTG 2009 PINNACLE 2010 IMPACT 2011 TVT Most comprehensive, outcomes-based quality improvement program in the U.S. and internationally A premiere source of clinical outcomes data Encompasses both hospital-based registries and a practice-based program Trusted, patient-centered resource Helps participating facilities: Identify and close gaps in quality of care Reduce wasteful and inefficient care variations Implement effective, continuous quality improvement processes

43 How many hospitals participate in NCDR? Name Disease or Device Facility Services Sites Patient Records CathPCI ICD Percutaneouscoronary interventions Implantable cardioverter defibrillators Cath Lab ,000,000 EP Lab ,000 ACTION-GWTG Acute coronary syndrome Emergency ,500 CARE Carotid artery revascularization Cath Lab Surgical ,000 IMPACT Congenital heart disease CathLabs w/ Congenital Service PINNACLE Coronary artery disease, heart failure, atrial fibrillation, hypertension Outpatient 800 physicians 3,000,000

44 The History: ACTION Registry-GWTG ACTION Registry transitioned from CRUSADE and NRMI Registries January 2007 ACTION was established May 2008 ACTION merged with AHA GWTG CAD to become ACTION Registry-GWTG Current membership of 730 Hospitals Over 350,500 records submitted

45 Purpose of ACTION Registry-GWTG National surveillance system for high-risk AMI patients admitted with STEMI/NSTEMI: Assess characteristics, treatments, and outcomes of this patient population Optimize outcomes and management of AMI patients through implementation of ACC/AHA evidence-based guideline recommendations in clinical practice Facilitate efforts to improve quality and safety of ACS patient care; and investigate QI methods

46 Inclusion Population Acute Myocardial Infarctions-STEMI & NSTEMI only Patient must present to 1 st Facility with symptoms of ACS, within 24 hours of arrival Patient must have positive ECG- ST elevation, new LBBB, or documented Posterior MI OR Positive Biomarkers- Troponin or CK-MB Transfer In patients-stemi must arrive within 72 hours, NSTEMI within 24 hours If the patient presents with any other symptoms, or procedures, the patient is excluded

47 Performance Measures Acute/In-hospital Measures Aspirin Arrival STEMI -Any reperfusion (PCI or Lytic) STEMI -Lytic -Door to Needle (Median Time and % <30min) STEMI -PCI D2B (Median Time and % <90min STEMI - D2B Transfer in (Median Time) LVSD Evaluation Discharge Measures Aspirin B-blocker ACE or ARB (EF <40%) Statin for LDL 100mg/dL Smoking cessation (among smokers) Cardiac rehabilitation

48 Door to EKG (within 10 min) Quality Metrics STEMI-Acute ADP Receptor Inhibitor Therapy Vascularized Patients Discharged on ADP Receptor Inhibitors ADP Receptor Inhibitors Prescribed at Discharge for medically treated patients LDL assessment (in-hospital) NSTEMI -Excessive Initial UFH Dosing (>70 U/kg bolus, >15 U/kg/min infusion) Excessive Initial Enoxaparin Dosing Excessive Initial GP IIb/IIIa Dosing STEMI -Anticoagulant-UFH, enoxaparin, bivalarudin or fondaparinux Aldosterone Blocking Agents at Discharge

49 Why Participate? The ONLY National Data Registry for Pts With AMI Hospitals data compared to the US aggregate National assessment and benchmarking of ACS care Measure your risk-adjustedperformance against national benchmarks Guide for future quality improvement efforts

50 What Do I Get? Comprehensive Outcome Reports Comparison Groups Quarterly Real Time reports Benchmarks Performance measures & metrics Hospital experience Like facility National experience Registry Dashboard Drill Downs Unique compare groups ACTION Registry-GWTG 2012

51 ACTION Registry-GWTG infrastructure supports research QI & Translational Research Performance gaps QI intervention and effect Guideline adherence Performance measure development acts 35 Manuscripts Published 50 Abstracts

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53 ACTION Registry-GWTG Performance Recognition Criteria

54 ACTION Registry-GWTG Performance Recognition Marketing Materials Seals Press Release

55 Thank you for your participation in today s webinar! Today s webinar has been recorded and will be available with the PowerPoint slides within 10 business days on the AHA Mission: Lifeline website. felinehomepage/missionlifelinetools/multimedia-presentations- Webinars-and-Videos_UCM_438836_Article.jsp

56 Contacts: Puja Patel, Hospital Accreditation Specialist Meagen Driskill, Manager of Hospital Accreditation